DSM

Yes I’ve been inactive on here for a while: work has taken over more and more of my time and energy. Things came to a head this Monday however. I took an overdose of lorazepam.

The following day I wrote this, as my attempt to iron out my thoughts. Put simply, I don’t understand why I did it. I don’t understand what’s happening to me.

Earlier my GP asked if I was depressed. Honestly I wasn’t. I most definitely did not want to return to work, so that’s something to stab at. But as my mother pointed out, I’ve been coming home from work for weeks, stating how I’m enjoying bookselling again. And I have been. However none of this changes the fact that there’s the parallel dimension – this alternate universe within my head saturated with white noise and hyper-thought and erratic compulsions.

I’ve been drinking more and more. Self-medication is the prevalent term I believe. The sense of release, the comfort; but also the trangression. Acting normal, functioning while under the influence. What’s fascinating/scary is that I can go off piste stone cold.

I call it the “Cold Flame”. Inside of me there’s this energy; something wondrous and beautiful and beneficial. But its most definitely a dangerous gift – sometimes my mind works every angle, turning things over and over and over and over. Simulating things which have happened, haven’t happened, could happen, can’t.

My eyes glow. Flames emanate from my hands. I’ll look over my shoulder and converse with my thoughts rather than merely think them. We are an army a million as many as your own (though there is sometimes sedition in the ranks). That “crazy” guy rambling to himself on the street? Hello. There’s a little more subtlety in my discourse, but if the lift door opens at the right time I’ll be there running my nails down the walls; clutching my head and waiting out the latest cacophony.

You may hear “We” instead of “I.”

I register people’s eye movements, lip twitches, the way they shuffle their feet or move their arms. The thoughts, concerns, opinions and emotions of others flood torrentially into my mind. I’m not deluded or arrogant enough to claim telepathy but hey, just because you’re not a bat, doesn’t mean you can’t hang upside down.

Some realisations wait in the wings; quietly murmuring their lines until some mysterious stage hand points towards the lights. An aroused audience of one bristles as our player stumbles across the boards. Flowering at last, a bloom of gestures and revelatory dialogue which can tranquilize or incinerate with a pyroclastic fervour.

Its been quite some time since I’ve posted on this site. Sat down and tried to fulfil the promise and purpose of this little domain which I long ago intended to discuss the aspects of, and issues around, “my illness.” A nebulous term which draws its authority from a peculiar and potentially dangerous branch of pseudo-science. Considering bipolarity a disorder has never helped me. Lithium reigned me in, though I cannot say that there isn’t an alternative method for equalising my moods. To my great shame a vein of cowardice – or worse apathy – makes it unlikely that I’ll ever seek one out.

Epilepsy has given me a metric by which to measure the pathology of my psyche. Epilepsy is quantifiable. EEGs can demonstrate wiring faults as effectively as any halfway competent electrician. The MRI sketches poured over and waved triumphantly above the heads of psychopharmacologists appear to suffer from an a certain object impermanence. Traction subsides, and the diagnoses and treatment plans of every mental health professional I’ve ever encountered comes from defaulting to a sort of conventional wisdom; perhaps characterised by instincts which would be familiar to Witchfinders General.

The last 36 words aren’t necessarily dismissive. Perception is everything after all. If you treat bipolarity as an illness – if that helps keep you as healthy and happy as can be – then that is the reality as it applies to you. My experiences (within and without mental “illness”) have instilled a Ballardian appreciation of unreality and dominant fictions of the world around me. The recalibration of my mind and moods comes from repeat attempts to calculate and reconcile the contradictions and inverted logic of the suspicious and deliciously perverted “real”.

From here on in, my thoughts and attempts to make my way through this world, will hopefully hinge upon a more conscious appreciation of these dim repressions. The human body is a mechanical wonder driven by powerful and adaptive OSs. To drive the mechanism onwards, to maintain its inward integrity whilst engaging with competitive systems, requires flexibility and mutation. Consciousness, the imagination, the psyche: all crucial constructs which can neither function nor exist within fixated boundaries.

The query has become: how do I function? The query has become: why do I function? The query has become: how and why don’t we function the same?

I had a psych appointment at 12.30. Having crash landed into the NHS Mental Health Trust 13 years ago, today came the novelty of having to produce my passport, a recent bank statement and a fully completed “Pre-Attendance Form.” To discuss these documents at the start of a health assessment, then having to wait as they were photocopied at the end.

Immigration and public services are hot button issues right now, perhaps in ways they haven’t been since the 1980s. As Chris Addison noted, we accidentally elected a Conservative government four years; and the rise of UKIP has ratcheted up every tension. Still, I’ve been in the goddamn system long enough to prove my entitlement status. And, crucially, personally, I don’t consider the PAF in the spirit of socialised medicine.

NHS funding principally comes from taxation. I am a tax payer. That illegal immigrants may be using the service has never pissed on my pancakes. Individual health benefits everyone. If you have to drive without a license, its better you don’t fall into a diabetic coma at an intersection. I’ll concede that our borders need policing, that immigration must be handled responsibly, but I can’t help but shudder when I read how information from the PAF can be passed to the UK Border Agency ‘…if it is deemed necessary by the trust.’ Patient information. I had to answer questions about the number of residents in my house. Number of hours I work a week. 13 years. The first time in 13 goddamn years.

Please note non presentation of the above documentation on the first appointment could delay your assessment and subsequent treatment.

I’ve contacted these people because I want to keep my options open, given my recent spikes in hypomania and bouts of whip-spin paranoia. I am relatively stable right now, so a delay wouldn’t do much harm. But I have to compare my current state of mind to Me at 17. Late teens, consistent self-injury, potent depression culminating in a dramatic suicide attempt that – while not taking my life – could have left me paralysed. My 17 year old self couldn’t wait. It was my mother stressing this that actually got me into the clinic. The trust wanted to release me back into the wild.

Everything about the NHS, particularly the mental health sector, just feels paradoxical and contrary and kind of frustrated. Even Dr Sri; the very paradigm of a dedicated, intelligent, sympathetic professional bemoaned this. That he couldn’t do more for his patients. I refuse to accept that the NHS, or socialised medicine of any stripe, is inherently doomed to fail. Any ill fate comes from incompetence and mis-management, hackneyed bureaucracy and financial derangement. Manipulation and greed.

A recent case centres on a Basildon man forced to pay £2000 per week to treat his brain tumours. ‘Avastin is not licensed by the manufacturer for treatment of brain cancers in England’, an NHS teeth-piece explained. As noted in the article, cosmetic surgery and gastric bands are readily available on the NHS. I don’t really object to these, but clearly we’re forced to come down on either side of this issue. That force is economic.

The devil is always in the unnerving machinations when it comes to Big Pharma. In the excellent Cracked.com article 5 Terrible Secrets Big Drug Companies Don’t Want You to Know, writer Andrew Munro recalls the curious history of Sarafem. Marketed by drug firm Eli Lilly as a treatment for premenstrual dysphoric disorder (PMDD), Sarafem was a breakthrough in the fight against an ‘…exaggerated form of PMT.’ The typical symptoms of PMDD (fatigue, emotional instability, anxiety, disinterest in daily activities and difficulty concentrating) may be familiar to those receiving treatment for depression, which is handy, considering Sarafem is Prozac by another name. And a pretty colour palette.

Munro: ‘…by releasing a new drug identical to Prozac, Eli Lilly managed to extend their patent by a few years, allowing the price of Prozac to remain nice and high.’ This is what we have to contend with, as “service users”. The administrative locust horde, frenzied by persistent interference from mandarins, transient politicians and “business managers”; whilst being undermined by low-quoting contractors and manipulated by opportunist corporations who’s spreadsheets can determine who lives and who dies. Now we can add crossing guards to the roll call.

I fear for the NHS. For all my criticisms, for all my ideological stances against the dominant psychiatric models, I have to accept that it has helped keep me alive. Given the sense of disquiet and violation I feel after today’s meeting, I fear for others like me, especially those younger than me, who now have another swamp of uncertainty to wade through. We have an increasing Eastern European presence in this part of the world. Whole new generations who may need access to mental health services. Young people, older people who’s misery, fear, torment, doubt, self-loathing, anger – the whole bloody rainbow of psychiatric crises – may now be compounded by a fear of incriminating themselves or those they love.

After 12 years I no longer have a psychiatrist. I’ll see my GP every so often for bloods and that’s it. Winding down has been touted in the past and we’ve always, mutually, decided that staying in the service was a good idea. Just to see. For my part there was some kind of fear of freedom – 12 years, and I will not deny that Dr Sri has done right by me.

Apparently I’m a ‘success story.’ He said this with the wistful tones of someone who rarely scores any wins. Dr Sri always acknowledged the collaborative effort involved, but I can’t help but feel that he’s missed certain details. I’ve done better because I could no longer operate as a victim. No longer infested; no longer suffering under some invasive disease entity. As trite as it may sound I tried to accentuate the positive and face the dark down rather than acquiesce to some spurious pseudo-scientific definitions. He gave me breathing space, and this is where I credit lithium because it gave me cover.

We fundamentally disagree on the nature of my disposition. I do not see disorder, certainly not pathology, and he wasn’t shy about telling me I was wrong. But he wasn’t militant about it, and we did respect each other. What’s sickening is that the quality of our relationship is something of a rarity. It has to be noted that part of the reason patients are being discharged from his books is because his unit is being wound down. He is moving onto a long term treatment programme – i.e. working with those we are told will never be “successes.” I know that his patients are fortunate to be under the care of such a patient, conscientious, intelligent and caring man. But he is wrong. Or, as he has hinted in the past, he is unable to afford his charges the treatment they might require. In at least one meeting he told me about his frustration with the service’s limited resources. Read into that what you will.

There was a certain degree of system shock when I left the meeting. I entered the service when I was 17. Crashing into it through blood and muddy water. I’m struggling to reconcile the disconnect between the person doing the talking and the fractal composition debating the issue upon our exit.

A safety net has been folded away. Getting back into the system is easier for alumni, but the principle is that (whilst not being cured), I am convenient enough to be released into the wild. I guess the question becomes what decisions can and should I make, now that its a little more unilateral around here?

My friend “A” recently completed her transition. We first met nearly two years ago when she was still a he, and had come into the store looking for books on gender identity and sexuality. Previously I’d only ever met one other transgender person: the recently reassigned husband of a man I was in hospital with. Given the strife this had put on the latter’s marriage I was (and remain) impressed with the confidence and candour with which A is able to discuss her experiences.

It would be idiotic of me to claim any expertise on this subject. For any true insights into the lives of transgender people and their loved ones, I heartily recommend gendermom – a mother’s blog about life with a trans daughter. For my part I have to wonder about my comfort with this issue. I come from a working class background lacking what you’d call progressive ideas around status, race, identity and sexuality. I’m confident that my family members who denounced blacks and faggots would struggle to even grasp the concept of someone born into the wrong body, even struggle to devise suitably offensive epithets.

Unfamiliarity breeds contempt. Contempt, suspicion, fear…a whole litany of negative responses. As kids we’d belittle and tease one another by calling each other gay. Its a cultural thing, and as with prejudicial attitudes towards the mentally ill, its likely to stem from a lack of contact with, and questions raised by, people of certain dispositions.

The Brothers Hitchens queried the validity of the term ‘homophobia’ on several occasions – stressing that a more literal reading of the word’s etymology is “fear of the same” as opposed to fear of homosexuals and homosexuality. Dear departed Christopher would run with this theme, noting how often homophobia rises from a doubt and disgust within the homophobe. Spectrally such doubt and disgust is common in transphobia and psychophobia – if their gender identity could be misaligned, what about mine? Could I hear voices too?

I often come back to a long ago conversation with my aunt. Mass immigration is a hot potato in these parts, and she was bemoaning the number of african families moving into the area. ‘I want ’em out’ she told me, ignoring one particular irony – one of my families’ best friends since my uncle’s 70s childhood is “Black Tony.” I pointed this out to my aunt. ‘Oh that’s different. That’s Tony.’

How would things be if we had “Gay Tony” or “Trans Tony” or indeed “Schizophrenic Tony” in our lives? Everyone in my family knows my story and diagnosis, and yet its all wary eyes and awkward shuffles when the topic comes up. Even as a simple statement; a matter of fact in a conversation, with all the emphasis and drama of someone announcing their transition from full fat to semi-skimmed milk.

Perhaps some would argument that because mental illness can have fewer, conspicuous traits (for example mincing or removing your dress and becoming a bricklayer), its harder to get a handle on, and know how you’re “supposed” to respond. Everyone gets depressed, but not everyone dresses like Freddie Mercury, so demarcation is complicated.

An obvious solution to this is to treat us like people. Easier said than done, but once the step is made positives aren’t hard to find. Young couples like Jamie Eagle and Louis Davies, Arin Andrews and Katie Hill are cases in point. These news stories don’t invoke the spirit of the freak show – sure they’re curiosities, but the emphasis is on people finding themselves and young love.

‘In May 2010, Jamie was diagnosed as transgender.’ This was the only part of the Mirror story which made me wince. The ‘D’ word. I’ll admit I have developed a particular sensitivity to clinical terms used in certain contexts – maybe Miss Eagle’s eyelids wouldn’t bat at all. Language assails us in different ways, and I immediately recalled how the Blessed APA no longer consider being transgender a mental disorder.

Curiously another part of this story drew my attention – the couple are from Bridgend County in South Wales; a part of the country regrettably known for its high suicide rates. I’m not drawing any connection here. I mention it because, as part of my own particular disposition, I see patterns and peculiar associations everywhere. Bridgend was a place I used to pay special attention to.

That this was the only negative I could find in the piece – one drawn from the quagmire of I – is a source of something approaching optimism and reassurance for me. Some kind of signal that our culture isn’t collapsing in on itself; folding into something rancid and inherently dismissive of the rights, needs and simple truths of the individual and those important to them.

Shouldn’t it be the easiest of questions to answer? If they gave you a pill, if transcranial magnetic stimulation works or some new gene therapy could cure your “disorder”; would you accept it?

Yes is the obvious answer, as far as any “sane” or “rational” or “healthy” person would have it. The reasoning behind this is obvious and with some validity – mental illness tears at the fabric of society, it destroys lives. It kills.

Why can’t I just answer yes? A friend of mine once told me how much she hates my scars, how she hates that pain was caused and that they were required. She also noted that I wouldn’t be the person she loved if I hadn’t lived through all that. Maybe that’s what she truly dislikes – that parts contributing to someone she values were born of misery and chaos.

I can’t answer yes. No. No I’m lying. Yes. Yes, yes yes. YES. In my darkest times I wanted it to stop. ‘It’ was so many things. Fear, uncertainty, misery, pain, loss. More besides. Anything I could try to cut out or ethanol-cleanse or suffocate at the bottom of the Roding.

The interesting question isn’t whether I would have such a treatment today, but whether I would have then.

In The Pits and the Pendulum Brian Adams highlights what he considers ‘manic-depression propaganda’: adding names such as Einstein, Coleridge and Alexander the Great to “our” pantheon. The only stories I ever read about paranoid schizophrenia in newspapers detail failures of hospital administration and the inevitable murdering resulting from it. Black and white thinking saturates the question of mental health on every level, in a dizzying array of permutations.

For my part I cannot recall any upside, nor any down. There was only the maelstrom, punctuated with moments of relief and release when I thought it was over or the torment had been tied off. Contemplation of any benefits of my condition were impossible, not because my mind wouldn’t have been open to such heresy, rather it was otherwise engaged.

I wrote a hell of a lot of bad poetry back then. Wrote a lot of awful songs and failed to play them on my guitar. Writing has been a constant throughout my life, but back then it had to happen in bursts. Narratives or long tracts like this one were almost impossible, contributing to my collapsing academic standards. Perhaps my point is that any creativity I had wasn’t birthed or enhanced because of my crises, simply that the flavour of it had changed.

When was I diagnosed with depression? An SNRI was prescribed at some point, which I find curious in retrospect. ‘Suicidal ideation‘ came later: dying was a practical consideration. A demarcation was under construction between myself and a world opposing me on principle. Incompatible.

Things were happening to me and from me. Any revelations or revolutions in me were carried on shockwaves, and if there have been any benefits their emergence relates to these shattering blows. The same way you blast precious minerals from the earth.

No safety protocols. Imagine if you will an accelerating train; brakes failing, wheels red from friction, the whole mechanism groaning with metal fatigue. Disengage any “sensible” prejudices you may have around the fear of pain, the fear of death. When the wheels buckle and the rails yield and you are carried off the mountainside. The contortion of colours and shapes, new sounds and unimagined sensations.

‘Reality is a postage stamp‘ musician Katiejane Garside once told us. J. G. Ballard claimed a debt to the mentally ill and was himself denounced as ‘beyond psychiatric help‘ thanks to the manuscript of Crash. Shanghai Jim took it as a compliment.

If the propaganda folds and we’re not all murderers, perhaps what we find is a neutral shift in perspective. As social animals bound by the laws of natural selection, we have to agree on certain conventions in order for our continued survival. The model falters however, because all thought is infinite and our awareness of this fact is too much to handle. Finding ways to co-operate has helped us thrive as a species, but knowledge of its cost undermines the remarkable gifts nature instils in us.

I recently read a paper published in Molecular Psychiatryback in 2008, accusing a gene called diacylglycerol kinase eta (DGKH) of being complicit in the onset of bipolar disorder. Statistics were never my strong point so a great deal of the article was lost on me, but the focus on ‘risk alleles’ and ‘polygenic disease‘ was interesting, though seemed to somehow miss the point.

An engine is very useful if you maintain it. See to its needs and it’ll take you where you want to go. Ignore it or push it too hard and its breaks down. You might swear at the car when it fails to live up to your expectations, but you don’t fix it by restricting its component parts.

This is an emotive analogy, courtesy of someone fearing an extinction event. ‘In a completely sane world, madness is the only freedom.’ Ballard again. Potential methylation of this proposed epigenetic, polygenic complex will sterilise people like us. Return us to a statistical norm that the Holy APA cannot actually quantify.

I can’t say I consider myself special, and maybe I hinge too much of my sense of self on identification with the Mad community. But conversely aren’t researchers similarly hinging too much on the existence of a disease and the possibility of a cure? Approaches on either side will inevitably suffer from ideological taint – participants in the aforementioned study were drawn from the US Department of Health and and Human Services, the National Institute of Mental Health and the Brookings Institution’s Center on Social and Economic Dynamics; arguably institutions with a vested interest in the biopsychiatric model and its social implications. The test samples came from subjects and controls who’s suitability was judged according to DSM-IV criteria, which is always reassuring. The paper also notes that similar, albeit larger genome-wide association studies are only possible thanks to organisations like the Wellcome Trust; which was founded by a pharmaceutical entrepreneur.

I have to acknowledge my own biases, and it’ll be an interesting day if irrefutable scientific proof of the biopsychiatric model emerges. Yet I still cannot shake the idea that just because bipolar disorder may have a genetic basis, it wouldn’t be proof of a disease. I’m not a anthropologist and I’m certainly not a evolutionary biologist, but I can imagine certain evolutionary benefits to mental “disorders” which arguably retain their value.

My experiences of depression: an intense focus on ills to myself and a sensitivity to those of the world. A warning sign, a pain response. Bipolar disorder: creative leaps and unique problem solving, married to an intense motivation to leave the cave and cross the valley. Here we share the depressive sensibility; both as a consideration of our situation, but also a crash dynamic – our bodies and minds slowing down in an equal and opposite reaction to the manic impulse. Schizophrenia: hyper-real processing of the world around us, drawing out the inward significance of who and what we are. An attempt to emphasise the individual so we do not stagnate.

I talk to the voices in my head, sometimes telling them to shut up, but more often than not as part of a dialectic. This post owes much of its content to a late night of augmented energy levels and accelerated thinking. Patty Duke, echoing an apparent trend amongst manic people, emphasised her ‘incredible command of the language,’ while a patient of Darian Leader’s remarked: ‘the right words were just there, I didn’t have to think anymore.’ Right now, as I feel myself ascending yet again, I know exactly what they mean.

My answer is no. I can’t say I’d want to be “cured.” I won’t speak for everyone. My rights are restricted to what I feel and what I believe. Science is not the enemy. The spiritual isn’t irrelevant. All we can work with are the qualities we have and the ways we work with them in kind.